POS1148 SONOGRAPHIC VARIATION OF SYNOVITIS IN RHEUMATOID ARTHRITIS IS SUGGESTIVE OF BONE MINERAL DENSITY CHANGE.
Authors: J. Chen, T. T. Cheng, Y. Chen
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is a chronic inflammatory disorder initiated from local synovium inflammation and consequently bone/cartilage destruction. Active disease status brings persistent inflammation, which stimulates the activation of osteoclasts, accelerating systemic bone loss and decreasing bone mineral density (BMD)(1). Ultrasound (US), a powerful tool for clinical practice, was reported to be beneficial for the prediction of new bone erosion and disease activity (2, 3), based on the synovitis grading recommendation by the European League against rheumatism- Outcome Measures in Rheumatology Clinical Trial (EULAR-OMERACT) Taskforce. The severity of RA synovitis is associated with local bone destruction; however, the impact on systemic bone loss is still unknown. Objectives This pilot study aims to investigate if the US-detected synovitis change is associated with systemic bone loss. Methods A registry was conducted in Chang Gung Memorial Hospital, Kaohsiung, from September 2014 till April 2021 to monitor BMD changes in patients with rheumatic diseases. In RA patients, we regularly assessed synovium change of bilateral wrist by ultrasound at enrollment and one year later, based on EULAR-OMERACT system(4), which is a semiquantitative grading tool incorporating both gray-scale synovial hypertrophy (SH) and power Doppler (PD) signal. These ultrasound scans were performed by an independent and well-trained rheumatologist, using MyLab 70 system (Esaote, Firenze, Italy) and B-mode frequency at 12–18 MHz. We performed a longitudinal scan of volar and dorsal wrists, observing GS and PD signals. All participants who underwent standard care for RA were followed at least three years to monitor BMD change, and those who underwent anti-osteoporosis therapy at index day were excluded. We defined improvement of US-detected synovitis (US+) as a change from high to low grade by EULAR-OMERACT score. Conversely, patients who failed improvement were recorded as “US- “, defined as change from low to high grade. Patients who improved one or more grades, such as from Grade 3 to 2 (or from Grade 2 to 0), were registered as US+1 (or US+2) and vice versa. If there is no change of synovitis grade, we registered as US+0. Results A total of 212 participants were enrolled in the current study, with a mean age of 56.0 ± 10.1 years and a mean RA disease duration of 13.6 ±9.1 years. In patients with US+, the mean change of hip BMD [defined as (final BMD-baseline BMD)/baseline BMD, in percentage] was 0.73 ±6.8%, while US- was -2.2 ±7.7% and US+0 -1.9 ±6.6% (p=0.047). in post-hoc analysis, US+ demonstrated borderline significance compared to US-(p=0.059) and US+0 (p=0.087) by Bonferroni method. Subsequent analysis (Figure 1 A) revealed that patients with US+2 presented preservation of hip bone mass (3.1 ±6.8%), followed by US+1 (0.1 ±6.8%) and then US+0. US-1 and US-2 showed rapid bone loss on the hip (-2.1 ±7.9% and -2.3 ±6.7%, respectively). Figure 1. Conclusion Persistent synovitis is associated with total hip bone loss, and detection of synovitis change by ultrasound with EULAR-OMERACT scoring system is helpful to predict hip BMD change. References [1]Tanaka Y. Managing Osteoporosis and Joint Damage in Patients with Rheumatoid Arthritis: An Overview. J Clin Med. 2021;10(6). [2]Moller B, Aletaha D, Andor M, Atkinson A, Aubry-Rozier B, Brulhart L, et al. Synovitis in rheumatoid arthritis detected by grey scale ultrasound predicts the development of erosions over the next three years. Rheumatology (Oxford). 2020;59(7):1556-65. [3]Mandl P, Balint PV, Brault Y, Backhaus M, D’Agostino MA, Grassi W, et al. Clinical and ultrasound-based composite disease activity indices in rheumatoid arthritis: results from a multicenter, randomized study. Arthritis Care Res (Hoboken). 2013;65(6):879-87. [4]D’Agostino MA, Terslev L, Aegerter P, Backhaus M, Balint P, Bruyn GA, et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardised, consensus-based scoring system. RMD Open. 2017;3(1):e000428. Disclosure of Interests None declared